Friday, 16 April 2010

Implementation 2010 - Message from Stephen McKernan, Director-General of Health

The transition Project has reached a significant stage with the completion of three key papers for Cabinet consideration.

After Cabinet’s decisions in December 2009 and January 2010, our focus has been the structures, project teams and work programme to implement the decisions from the Ministerial Review Group. We’ve made progress on many fronts over February and March:

• Organisation change to move and establish new functions – this has included formalising the structure of National Health Board Business Unit within the Ministry of Health, clarify the location of Health Workforce New Zealand, setting up a shared services agency establishment board and a new quality agency
• Policy decisions that may determine the scope and range of roles and functions now under consideration – prioritisation of new technologies and interventions, the purchase of medical devices, improving decision making in the system and progressing responses to the MRG’s recommendations
• Legislation to enable new structures and functions to operate effectively with amendments to the New Zealand Public Health & Disability Act.

We would normally progress structural, policy and legislation change sequentially. However, we are moving on all fronts at the same time to ensure that the Government's desired settings to better support system performance are in place for most of the 10/11 and ahead of the 11/12 year. With a financial outlook that will continue to be constrained, the objectives driving the changes are even more significant:

• Stronger clinical leadership in decision making
• Accelerating improvements in quality and safety
• Higher system performance and securing future sustainability of the health and disability system
• Improved national and regional service planning and decision making
• Minimizing administrative costs and reducing bureaucracy and waste.

Ministry of Health and NHB organisation change
A discussion document has been released outlining a proposal for consultation about the structure of the Ministry of Health. The proposed changes are designed to align the Ministry structure with the changes to the way the health and disability system is configured.

While the majority of people will not be directly impacted by this proposal in its current form, it will see a nett reduction of about 35 Full Time Equivalent positions as well as some significant shifts in how we are organised to do our work. Many in the sector will be working closely with those affected and need to be mindful of this over the next few months.

One objective of the change programme is to reduce established Full Time Equivalent roles. There have been a number of different figures quoted in the media which has caused some confusion and I thought it would be useful to clarify these and provide some context.

In October 2009 when the current health system changes were announced, the Director-General also outlined the intention to reduce the Ministry’s establishment from 1475 to 1390 by 30 June 2010 and 1290 by 30 June 2011 – a reduction of 185 FTE positions over two years. The current proposal is part of that.

Separate to the programme above, 200 vacant FTE positions were disestablished from the Ministry in July 2009. These vacancies were achieved largely through attrition and the work in the Ministry over the preceding two years to improve efficiency and focus more on service providers.

Final decisions on the Ministry and National Health Board structure are due early May. It is important, however, that you continue to work with your Ministry of Health counterpart as per normal unless you are formally advised that your contact has changed.

Quality Commission
Following Cabinet’s decisions in December 2009, Dr Ashley Bloomfield, Acting DDG Sector Capability & Innovation (SCI) has set up a project to establish what’s been given the working title of the Quality and Safety Improvement Commission. He will complete advice to Cabinet on the roles, functions and powers the Commission will need to function. To date: 

• A process for the appointment to the Commission Board closed with 102 nominations. The final panel will be selected based on interviews with candidates who meet selection criteria.
• A sector advisory group has been established and has met several times by video conference to inform advice to Cabinet on the roles, functions and necessary powers of the new Agency.
• We are learning from the experience of other jurisdictions by talking to international quality and safety agencies and discussing opportunities for more formalised strategic relationships and partnerships to accelerate the establishment of our own agency.

Cabinet decisions are due by the end of May 2010. These decisions will inform legislation amendments that will provide for the new Commission in statute and establish its roles, functions and powers in law.

We would like to express special thanks to the many clinical and health professional leaders in quality who have been so giving of their advice in very challenging timeframes.

Shared Service Entity
The Shared Service Establishment Board is completing the first stage of advice on the shared service model, functions and form of a shared service entity and the appropriate legal form to be undertaken. Advice to Ministers and Cabinet on the preferred legal form for the entity will be completed by the end of April 2010. DHBs are represented on the Board by Lester Levy, Chair, Waitemata District Health Board and Chris Lowrie, General Manager, Capital & Coast DHB.

MRG related policy progress
Further work underway that will be reporting to Cabinet by end of April includes: 

• Roles and functions of the National Health Committee to prioritise new interventions and technologies in the health and disability system. The Minister of Health has released Cabinet papers that provide background to these decisions.
• Procurement of medical devices, hospital medicines, vaccines and the potential role for Pharmac’s remit is currently engaging with senior clinicians and health professionals led by Dr David Sage.
• The likely planning, funding and accountability settings that enable national and regional service planning and improves decision making in the health and disability system, while addressing barriers to regional and national collaboration.
• Further consideration of MRG recommendations in more detail.

Message from Chai Chua, National Director, National Health Board

National Health Board Formation
We have almost completed the establishment of all three Boards that will advise the National Health Board, the Minister and the Director-General on capacity planning and decision making - workforce, IT and capital planning. These are all from capacity planning.

Health Workforce New Zealand (HWNZ)
Cabinet agreed in February to establish the Health Workforce New Zealand as a branded business unit inside the NHB Business Unit with its Board continuing to report to the Minister. The group will now be referred to as Health Workforce New Zealand or HWNZ.

The HWNZ Board has been meeting monthly since November 2009 and will release its 10/11 Annual Plan before the 30 June 2010. The Business Unit incorporates the former Clinical Training Agency and Strategic Workforce Development Unit.

National Health IT Board
Many of you will be aware that a lot of detailed work has been completed in recent weeks to identify the sector's health IT priorities and to better understand which health information solutions should be delivered nationally, regionally, or locally. This has involved people from across the sector and Ministry, working together with the guidance of the Health IT Board.

This work is now at a point where we are ready to develop a more detailed programme of work. One of its priorities for delivery by 30 June 2010 is a National Health IT Plan that is accepted by the sector and has the support of the Minister of Health and the National Health Board.

I am delighted to advise that Graeme Osborne has agreed to lead this work and has accepted my offer of an interim executive role for three months (1 April - 30 June 2010). This means Graeme’s role as Chair of the Health IT Board will be picked up by Murray Milner who was Deputy Chair during this time. Murray will ensure that the Health IT Board continues to provide the Governance and oversight to ensure the Work Programme being developed is robust and allows us to better understand and meet the IT needs of the sector and the Ministry.

During his work with the NHB, Graeme will report directly to me and work with David Miller and the Senior Leadership Team. He will also report to the National Health IT Board and lead the interim NHITB – Business Unit.

We are lucky to have someone with Graeme's skills, experience and detailed knowledge of health sector IT needs. There will not be any reporting line changes with the Information Group as a result of this arrangement.

Capital
Ministers are close to signing off the Terms of Reference for the Capital Investment Committee and a revised process for considering capital proposals. We will advise the sector on the process and first meeting for the Capital Investment Committee to meet as soon as possible.